The Hemp Connection:
coping skills

For the last few weeks, we’ve been looking at the grief process through the lens of DABDA (a model that focuses on the stages of grief – denial, anger, bargaining, depression, and acceptance). When it comes to dying, acceptance is important¸ but not necessarily critical – if you’re terminally ill, you may die before you reach a place of acceptance. With PCOS though, you’ve got a life-long condition. If you don’t accept it, you’re likely not taking care of it properly. The good news is that acceptance is something you can learn.

Acceptance looks like:

• Generally being pretty okay with what’s going on, even when it’s unpleasant (so you don’t like hearing that you’ve got pre-diabetes, but you’re going to do the recommended diet consistently)
• Eating, sleeping, and exercising appropriately, even when you don’t feel like it
• Practicing good self-care, even when it’s inconvenient
• Having a stress reduction practice, such as meditation, yoga, or therapy
• Being grateful for what you do have (if you can’t quickly create a list of at least ten items, you may be dealing with low self-esteem or depression, which can be helped through therapy)
• Being genuinely happy about the positives of your life – kind of like being grateful, it’s about having a balanced perspective, rather than just focusing on the negatives
• Treating others with kindness, because it’s the right thing to do, and you’re not so angry about where you are and what you’ve got that you’re taking it out on them
• Not constantly comparing yourself to others, because you don’t need to – you know you’re not perfect, but you’re okay with it, and you’re working on what you can
In other words, happiness is about balance, perspective, equanimity, self-respect, and self-care, all coming together to remind you on a regular basis that you’re actually pretty okay, in spite of your PCOS – and even though the PCOS is a drag¸ you believe you can manage it.

Although this concludes our review of the DABDA process, we’ll look at bringing it all together (remember, grief is a non-linear process, and these emotions can pop up at any time, or repeatedly) and incorporating it as a permanent point of reference.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

This week continues our discussion about PCOS and the grief process, through the DABDA (denial, anger, bargaining, depression, and acceptance) model. Depression is so common among PCOS patients that I write about it quite often. It’s important for you to remain conscious of the clues that you may have depression. Many, if not most of my PCOS patients have some form of depression.

When we’re talking about depression in the context of death and dying, it looks like it does in PCOS too. If you’re suffering from depression, PCOS-related or not, it might look like:

• Sleeping too much or not enough
• Eating too much or not nearly enough
• Being irritable, snappish, and short-tempered
• Feeling suicidal
• Feeling hopeless about your future
• Feeling helpless to do anything to make things better
• Having an overall gloomy, pessimistic perspective on life

It is certainly easy to feel down when you think about the fact that PCOS is so challenging, misunderstood, and often misdiagnosed, and mistreated. It is one of those conditions that benefit less from standard medical treatment and more from diet, exercise, and good self-care. It comes with embarrassing physical symptoms that are time-consuming and costly to manage. There’s not a lot of research being focused on the condition. All of that is definitely overwhelming.

Not to mention, the hormonal imbalance inherent to PCOS can cause depression, even if you manage to maintain a positive attitude, take good care of yourself, and have a good support system. Sometimes, depression invades your mind and soul, because your body’s overwhelmed your coping mechanisms. Depression is best-treated by a professional therapist, sometimes with the assistance of a medical doctor known as a psychiatrist (a specialist in psychotropic medications – medications for mental health conditions).

Next week, we’ll talk about the final stage of the DABDA process – acceptance.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

As you’re reading this blog post, I’ll be heading off to my long-time gynecologist/surgeon for a pre-surgery briefing, signing of consent forms, and preparation instructions for an outpatient surgery to remove a cyst from my left ovary the following week. For some of us, it’s regrettably routine, and for others, the idea of having surgery is very frightening. The fear may be constant or fleeting, depending upon your history.

In my case, I would ordinarily not be afraid, but I had surgery two years ago and ended up with a deep and painful pelvic infection that took months to truly resolve. To say that I was terrified of returning to the same hospital would be putting it mildly – I think I had a near-hysterical reaction initially. Here’s what I did to calm myself, which I hope will be useful to you as you face your medical fears.

Identified alternatives – I considered another hospital (but my doctor is only on staff at this one), another surgeon (no, thanks, I need someone who knows me well and whom I trust implicitly), delaying the surgery (again, no thanks, as this has become a chronic pain situation over the last few months), or not having the surgery at all (this didn’t seem viable either, for the aforementioned reasons).

Researched/gathered information – in addition to talking extensively with my physician, I spent a fair amount of time with my nose in some books, and talking to my medical practitioner friends, as well as reading research and opinions on the internet. I always say, knowledge is power. But in this case, I may have scared myself unnecessarily by being a little too well-informed.

Consulted with other experts – I consulted with a physician/friend who knows the surgeon, an infectious diseases expert about how to ensure that I don’t get another infection, and people who have been through scary medical procedures themselves.

Took my time – I took my time, partly because of my schedule, partly because of my doctor’s schedule, and partly because I really don’t want to have surgery, and I was hoping the matter would resolve on its own. I tried a lot of alternative approaches, which helped, but I’m now confident that surgery is the right choice.

Considered risks, benefits, and outcomes – the risks include loss of the ovary, potential infection, or of course death (they put that on all the consent forms). Benefits include relief from pain, restoration of normal and comfortable functioning, and relieving my body of some diseased and dysfunctional tissue. Given the precautions I’m taking, along with my choice of highly esteemed surgeons, I expect the best possible outcome.

Came to peace with an imperfect decision – I really, really, really don’t want to have surgery! And I don’t want to go back to that hospital, and I don’t want to lose my ovary. But I also know that I can’t reasonably continue dealing with the level and frequency of pain I’ve endured for the last few months, the surgeon is excellent, the hospital’s outpatient department is better than its inpatient services, pharmaceutical treatments aren’t containing it or remedying it, and alternatives work well for a bit, but aren’t a permanent solution. I’m okay with my decision, regardless of the outcome. I’ve done the best for my body and my peace of mind, and that’s all I can do.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

A friend of mine is a two-time survivor of breast cancer. She is a single woman, diagnosed at age 40, who chose a double mastectomy and reconstructive surgery. Along the way, she’s had a lot of challenging medical procedures, fears, and unpleasant side effects. After dealing with the immediate medical issues, she realized she was depressed, and turned to the internet for help.

She found numerous online resources for cancer, and breast cancer specifically. She was steeped in depression, lethargic at best, but that’s when she got angry! Her anger pleased me as a therapist, by the way, because getting angry often leads to action, and she needed to take some serious action to get out of her depression. She found that there were a lot of people saying “Why me?” about cancer. (As an aside, there are two very helpful organizations online called www.whyme.org for pediatric cancer and www.y-me.org for breast cancer.). But what she said to me is “Why NOT me?! Who am I to be so special that I escape a very common disease?” She found “why-ing” to be pointless and actually an impediment to her getting well. And here I’d been thinking that it was a perfectly reasonable question!

I’d venture a guess that you’ve said “Why me?” more than a few times when it comes to your PCOS. I know I have. There are many questions and thoughts that come along with that first thought, and all of them have the underlying subtext of “THIS IS SO UNFAIR”:

• Why do other women get to go on a diet and lose weight with relative ease?
• Why do other women get pregnant by accident, and I tried for a decade and it never happened?
• Why do I have to shave my face every day (or spend thousands of dollars on laser hair removal and electrolysis)?
• Who is ever going to love me/want to have sex with me when I look like this?
• Why do I have to take all these supplements?
• Why can’t I eat carbs like normal people?
• WHAT is happening with my hair?
• Why do I need an endocrinologist? And a cardiologist? And, and, and…

It IS unfair. It’s expensive, inconvenient, awkward, uncomfortable, scary, humiliating, enraging, and a whole lot of other things. And yet, the reality is, 10 – 20% of women have PCOS. You are fortunate enough to know that you’ve got it, so you can start dealing with it proactively. You found this blog, and hopefully some other resources. As http://en.wikipedia.org/wiki/Wilhelm_von_Humboldt Karl Wilhelm von Humboldt says, “How a person masters his fate is more important than what his fate is.”

So your fate is PCOS. I know it’s a hard thing to accept. But once you can move to acceptance you can take action. Mastery of your fate means taking control, and making choices that support your good health. It means understanding that, although genetics dealt you a bad hand, there are many things you can do to positively affect the daily quality of your life, and your long-term health, well-being, and longevity.

Instead of saying “Why Me?” (and really, it IS okay to say it every now and then – you’re not perfect, you’re human, and a little self-pity may be a necessary step along the road to further and fuller acceptance), see if you can feel a shift in your mental landscape by saying “Why not me? Yeah, why not me?” Then move forward from there with something more productive.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

1. slogging present participle of slog (Verb)
1. Work hard over a period of time.
2. Walk or move with difficulty or effort.
Merriam-Webster Dictionary

There’s a brief, brutal sentiment that is often-repeated: life is short, and then you die. Well, yes, in sum, that is true! But in the meantime, there are many other things we want to accomplish, or must accomplish. Some of them are small, like purchasing groceries for the weekend. Mostly, we do the little ones without too much thought. Others are more intermediate, and require a little more planning. Some are downright gargantuan. It’s the big ones that tend to overwhelm us — tasks such as:

• Getting through high school, college, or an advanced degree.
• Becoming pregnant – then actually giving birth, and taking care of that child for 18+ years.
• Marrying, or engaging in any sort of long-term relationship.
• Surviving cancer treatment, or the death of someone close.
• Having PCOS, or some other chronic illness.

We get overwhelmed because we have a vision of the end – the baby, the job, the spouse, the degree, the skinny body, or merely being alive – but we have no idea how we will get there. Oh, maybe some vague idea, like yes, I’ll go back to school and learn Spanish and then I can get a better job (doing what again? Oh, details!). Somehow, all of our inner resources go flying out the window, and we think:

• It’s too hard.
• It will take too long.
• I don’t have the money.
• Everyone knows there’s a 50% divorce rate in this country.
• People will laugh at me.
• This isn’t something you can cure.
• I’m not smart enough.

And here’s where the “Art of Slogging” comes in. Slogging is hard work, patient attention, struggling, pausing, gathering up more energy, and going at it again and again, until you get IT, whatever IT is. I’ve had clients who went to six different junior colleges in three states over five years pull it together to get a local college to grant them an A.A. degree. That’s slogging. You might lose 12 pounds over the course of a year – a pound a month – because you went to the gym religiously twice a week, even though you didn’t think you were really seeing results. That’s slogging. Or you have no idea how you’ll respond to full-scale PCOS treatment, but you go to the endocrinologist, and the dietician, and the psychologist, and somehow, after some time and concentrated effort, and following instructions, you “suddenly” feel better. That’s slogging.

Slogging is the process of showing up for life, having some faith, a glimpse of hope, and the willingness to engage in a great deal of effort on an ongoing basis. It’s believing that your goals are worthy, you’re worthy, and you CAN do it. Slogging is life, basically. We get the gift of significant insights or progress at times to motivate us, but it’s still all about the slogging.

I believe you’re capable of virtually anything; what do you believe?

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.

Polycystic Ovary Syndrome (PCOS) is a complicated, often frustrating condition that affects many women who are experiencing infertility, or may even be a primary cause of infertility. Symptoms typically include recurrent ovarian cysts, excess hair growth (or hair loss similar to male pattern baldness), acne, skin darkening, difficulty losing weight, and, of course, trouble getting pregnant. Often, the condition is not accurately diagnosed until failure to get pregnant results in referral to a reproductive endocrinologist, who has specialized training in PCOS and other endocrine disorders.

Any of these conditions taken singly are difficult to deal with – but the combination is often overwhelming for patients who have been diagnosed with PCOS. PCOS is particularly difficult because it’s under-diagnosed, so you may have years of vaguely troubling symptoms before the diagnosis is made and treatment begins. The physical side effects are unattractive and visible to the world — “I’m fat, pimply, and hairy,” as one of my clients stated tearfully. Friends and relatives may assume that you’re lazy or eat too much, and that’s why you aren’t losing weight. As a result, depression and low self-esteem are very common among women with PCOS.

I was diagnosed with PCOS in my early twenties, and, as both a patient and a professional, I have learned that there are many things you can do to improve the quality of your life and your health with PCOS. You can take control of your health and mood now by doing the following:

Get educated: Do some research on the web, ask your doctor a lot of questions, join a support group and use it, read the RESOLVE newsletter, and stay on top of developments in treatment.

Obtain skilled medical help: Although an internist or general practitioner may diagnose PCOS, it is more likely that a gynecologist, endocrinologist, or reproductive endocrinologist will do so. If you have PCOS, you will most likely want to have an endocrinologist who will prescribe appropriate medications, monitor you for the potential development Type II diabetes, and coordinate with your reproductive endocrinologist while you are trying to get pregnant. Because it is common to experience higher rates of thyroid disorder and heart disease when you have PCOS, it is a good idea to have frequent monitoring.

Your physician can also:

help you lose weight with the assistance of certain medications, and/or referral to a skilled dietician, who can teach you how to eat in a way that contributes to balancing your hormones and managing your symptoms;

refer you to a good dermatologist, who can help to control or eliminate skin conditions related to PCOS, such as skin darkening and acne, and even help with treatments for hair loss;

suggest a therapist or support group to help you cope with the stress of infertility, symptoms of depression, and frustration of dealing with a chronic disease;

Exercise: Yoga will resynchronize your brain, produce deep relaxation, reduce stress, and enhance your acceptance of your body, just as it is in the moment. The cross-lateral motion of walking is also highly effective in regulating PCOS-related insulin resistance, controlling weight – and, surprise! – resynchronizing your brain waves.

Look better so you feel better: In addition to seeking the help of a dermatologist for skin and hair conditions, you might want to actively manage excess hair growth cosmetically. There are many ways to do this, but electrolysis is the only method that has been proven permanent. A licensed electrologist will have a great deal of experience with PCOS patients. Your dermatologist can provide you with a reliable referral.

Although weight gain around the middle is frustrating and hard to overcome when you have PCOS, you can learn how to dress well, no matter your size or shape – and you deserve to do so! Seek out current fashions that are figure-friendly, and get help when you need it – if you’re just not good at putting outfits together, ask a friend who is good at it to go shopping with you, use the free services of a department store personal shopper, or spring for a stylist who will help you figure out what works on you.

Don’t forget your brain: Education is only one element of what your mind needs to effectively cope with the stress of PCOS. Sometimes friends, partners, and physicians aren’t quite enough to help you work through your anger, frustration, irritability, and sadness about having PCOS, not being able to get pregnant, or the difficulty you experience losing weight in spite eating well and exercising regularly. A licensed counselor or therapist can help you decrease stress, develop personalized coping methods, enhance your support group, and identify additional resources. Many therapists utilize mind/body methods that include meditation, guided visualization, mindfulness, and other ways of supplementing your good health practices.

By actively taking care of your physical and mental health and appearance, you can learn to feel better by knowing that you are doing the best you can with a challenging condition.

Dr. Gretchen Kubacky is a licensed clinical psychologist in private practice in West Los Angeles. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders. If you would like to learn more about Dr. HOUSE or her practice, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com.

Reprint permission granted by RESOLVE: The National Infertility Association, 2009. www.resolve.org.

You know you’ve been there – reaching for the cookie jar again and again, or woefully looking into the bottom of a bag of chips. Feeling sick, disgusted, out of control, sad and angry. Cursing yourself for giving in to the urge again. If you’ve got a problem with binge eating, there’s no perfect way to avoid it forever, but the key is to stop and think before you act. Here are my favorite ways to put the brakes on a binge:

Triple wrap your treat in foil, plastic wrap, and a plastic bag. Shove it in the deepest, darkest corner of the freezer. I know chocolate chip cookies taste great frozen (and semi-stale, and raw, and even when you have to pick the raisins out of them), but this will slow you down.

Before going to a potluck (and I am not casting aspersions on your family, friends, or colleagues), remind yourself of all those studies documenting that one-third to one-half of people do not wash their hands after using the restroom. Did one of those people prepare that casserole full of fatty pasta you’re about to dig into? Just asking…

Make a public declaration, and allow your shame to come quickly to the forefront if you violate it. I know if I say I’m following a special diet that temporarily eliminates wheat and dairy, you can bet someone will question me if I start heading for the cheesecake. The only way out is to contain myself.

Eat dessert first. Your mother isn’t standing over your shoulder, telling you what to do anymore. If you want dessert more than anything, give yourself permission to eat it first, and know that you are allowed to have whatever you want.

Put a time limit on it. If you really can’t resist, set a timer for three minutes and eat what you will. Not a perfect remedy, but you will contain the damage.

Love your food. Really love it. The more you love something, the more difficult it is to abuse. Remember that about yourself as well.

Forgive yourself if none of the above works. Forgive yourself if nothing you’ve ever read or heard or been told by your dietician works to keep you from binge eating. There’s always another opportunity to do better.